Cultural Variability in the Manifestation of Expressed Emotion

Department of Psychology, University of Southern California, 3620 S. McClintock, Los Angeles, CA 90089-1061, USA.
Family Process (Impact Factor: 1.73). 07/2009; 48(2):179-94. DOI: 10.1111/j.1545-5300.2009.01276.x
Source: PubMed


We examined the distribution of expressed emotion (EE) and its indices in a sample of 224 family caregivers of individuals with schizophrenia pooled from 5 studies, 3 reflecting a contemporary sample of Mexican Americans (MA 2000, N = 126), 1 of an earlier study of Mexican Americans (MA 1980, N = 44), and the other of an earlier study of Anglo Americans (AA, N = 54). Chi-square and path analyses revealed no significant differences between the 2 MA samples in rates of high EE, critical comments, hostility, and emotional over-involvement (EOI). Only caregiver warmth differed for the 2 MA samples; MA 1980 had higher warmth than MA 2000. Significant differences were consistently found between the combined MA samples and the AA sample; AAs had higher rates of high EE, more critical comments, less warmth, less EOI, and a high EE profile comprised more of criticism/hostility. We also examined the relationship of proxy measures of acculturation among the MA 2000 sample. The findings support and extend Jenkins' earlier observations regarding the cultural variability of EE for Mexican Americans. Implications are discussed regarding the cross-cultural measurement of EE and the focus of family interventions.

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Available from: Nicholas J K Breitborde
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    • "r problems relative to other racial / ethnic groups . However , some findings suggest that EOI may be maladaptive even within these Hispanic / Latina groups , given its association with higher relapse rates among adult Mexican Americans with schizophrenia in several studies ( e . g . , Aguilera , López , Breitborde , Kopelowicz , & Zarate , 2010 ; López et al . , 2009 ) ."
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    ABSTRACT: Emotional overinvolvement (EOI) in parents' Five Minute Speech Samples (FMSSs; Magaña-Amato, 1993) is thought to measure overconcern and enmeshment with one's child. Although related to maladaptive outcomes in studies of adult children, FMSS EOI evidences varied relations with behavior problems in studies with young children. These mixed findings may indicate that certain FMSS EOI criteria reflect inappropriate and excessive involvement with adult children, but do not indicate maladaptive processes when parenting younger children. Thus, this study evaluated relations of each FMSS EOI criterion with changes in child behavior problems from preschool to first grade in a community sample of 223 child-mother dyads (47.98% female; Wave 1 Mage = 49.08 months; 56.50% Hispanic/Latina). Maternal FMSS EOI ratings were obtained at Wave 1, and independent examiners rated child externalizing and internalizing behavior problems at Wave 1 and again 2 years later. Path analyses indicated that both the self-sacrifice/overprotection (SSOP) and statements of attitude (SOAs) FMSS EOI criteria predicted increased externalizing problems. In contrast, excessive detail and exaggerated praise were not related to child externalizing behavior problems, and Emotional Display was not evident in this sample. None of the FMSS EOI criteria evidenced significant relations with internalizing behavior problems. Multigroup comparisons indicated that the effect of SOAs on externalizing behavior problems was significant for boys but not for girls, and there were no significant group differences by race/ethnicity. These findings point to the salience of SSOP and SOAs for understanding the developmental significance of EOI in early development. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Jul 2015 · Journal of Family Psychology
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    • "Kingdon and Turkington [7] for instance, suggested that relapse can be linked to life events and circumstances such as low-key but enduring type of stress or due to specific factors that trigger anxiety to which the person is vulnerable. One of the main contributory factors that have been consistently found to relate to relapse is the emotional climate of household environment demonstrated by family members toward people with schizophrenia known as the expressed emotion (EE) [8] [9] [10] [11] [12] [13]. EE has been considered as " … a thermometer of affective family environment… " [14, p.80] and it has been suggested to reflect family members' general attitudes toward patients with schizophrenia in their daily interactions [15]. "
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    ABSTRACT: BACKGROUND: Schizophrenia which is perhaps the most disabling and puzzling form of a mental disorder is often conceptualized as 'gila' (lunacy or madness) by the Malaysian society. The debilitating nature of the disorder and recurrent relapse of its psychotic episodes have often been misunderstood and lead to confusion among the family members, who play the role as primary caregivers. While expressed emotion (EE) has been widely studied in the Western world, it is not well understood in Malaysia. OBJECTIVES: This study aimed at investigating the predictive role of relatives' EE index and components as well as personality traits in relapse among schizophrenia patients in Kuala Lumpur and Klang Valley, Malaysia. METHODS: A total of 160 subjects consisting of 80 patients diagnosed with chronic schizophrenia and 80 relatives were recruited to participate in Phase 1 of the study. Only patient-participants were followed-up 6 months later for Phase 2 of the study in order to check for possible relapse. The Family Questionnaire (FQ) and the short scale Eysenck Personality Questionnaire-Revised (EPQ-R) were administered to measure relatives' EE and personality traits, respectively. Patients' were considered to relapse if they were readmitted into psychiatric wards 6 months post-hospital discharge. RESULTS: The findings revealed that the odds for patients to relapse were increased by 8 times when relatives demonstrated high-EE level. Relatives' critical comments (CC) turned out to be the strongest predictor with the odds to relapse increased by 12% when they demonstrated an increase in CC level. Relatives' personality traits particularly the extraversion trait also turned out to be the significant direct predictor to patients' relapse. Our results showed that a unit decrease in extraversion trait score predicted the odds for patients to relapse by 23%. DISCUSSIONS: Our findings supported the Western findings on the significant role of relatives' high-EE level particularly the CC scale on the course of schizophrenia. The novelty of the current finding was demonstrated in the significant role of relatives' extraversion trait that directly predicted patients' relapse. Results also indicated the feasibility of EE in predicting relapse among schizophrenia patients in Klang Valley, Malaysia.
    Full-text · Article · Jan 2013 · Comprehensive psychiatry
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    • "CFI studies have demonstrated that hostility is rarely seen in the absence of high-EE based on criticism. Thus, researchers using the CFI often combine these categories (e.g., Weisman et al., 1998, 2000; Lopez et al., 2009) and newer systems of rating EE, such as the Five Minute Speech Sample (FMSS; Magaña et al., 1986), do not measure hostility as a separate component; instead, it is combined with criticism. EE is important because it is a robust predictor of illness prognosis across a broad range of psychiatric disorders (Wearden et al., 2000) and, with a few exceptions, across a range of cultures and ethnic groups (Weisman de Mamani et al., 2009). "
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    ABSTRACT: Expressed emotion (EE) is a measure of the family environment reflecting the amount of criticism and emotional over-involvement expressed by a key relative towards a family member with a disorder or impairment. Patients from high EE homes have a poorer illness prognosis than do patients from low EE homes. Despite EE's well-established predictive validity, questions remain regarding why some family members express high levels of EE attitudes while others do not. Based on indirect evidence from previous research, the current study tested whether shame and guilt/self-blame about having a relative with schizophrenia serve as predictors of EE. A sample of 72 family members of patients with schizophrenia completed the Five Minute Speech Sample to measure EE, along with questionnaires assessing self-directed emotions. In line with the hypotheses, higher levels of both shame and guilt/self-blame about having a relative with schizophrenia predicted high EE. Results of the current study elucidate the EE construct and have implications for working with families of patients with schizophrenia.
    Full-text · Article · Feb 2012 · Psychiatry Research
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